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‘Age wave’ pushes change in health care industry

A community dining room, community fireplace/lounge, resident unit and therapy/gym are all part of the new St. Crispin Living Community opening its doors this spring at 213 Pioneer Road. Illustration by Pope Architects

Editor’s note: This is the first in a series of stories about the new, state-of-the-art long-term care facility that St. Crispin Living Community is opening this month in Red Wing.

Red Wing, like the rest of Minnesota, is experiencing an age wave.

Four years ago nearly 1 in 5 city residents was 65 or older. Some 285,000 Minnesotans will turn 65 this decade. By 2020, there will be more seniors than school-age children in the state.

One of the fastest growing populations is adults 85 and older — seniors who often develop unique health care needs including Alzheimer's disease and related dementias. Demand for memory care services is expect to increase another 17 percent by 2025.

The implications of those statistics have prompted health care and long-term care facilities to examine how they can adapt to meet communities' looming needs.

Jake Goering, administrator and CEO of St. Crispin Living Community, has devoted the past six years to answering some core questions: What infrastructure must be created? What processes must change? How can the shortage of qualified health care workers be overcome?

Goering came to Red Wing in 2012 when the Benedictine Health System acquired Seminary Home from Fairview Health Services. That same month Mayo Clinic Health System acquired Fairview.

The Benedictine Health System decided to focus its development efforts at its Pioneer Road property, including St. Brigid's at Hi-Park, a nursing home, and the adjacent Villa at Hi-Park.

The result is St. Crispin Living Community, a campus that offers a full range of options for seniors, from independent living and assisted living to specialized memory care, short-term and long-term care, and skilled nursing care.

The community offers a home to seniors, including couples, as they transition through different phases of life. With this "continuum of care," Goering said, "People can age in place."

The project is nearing completion. A new 64-bed St. Crispin Care Center, with additional areas designated for memory care and transitional care, is nearing completion where St. Brigid's stood.

The care center represents a new concept in nursing homes. It is designed as a community with four neighborhoods on two floors. Each neighborhood has 16 fully furnished private suites and shared living spaces for dining and gathering.

The campus also has areas for memory care, transitional care and therapy, plus a chapel and a kitchen.

During construction, the nearby Villa was updated for independent and assisted living residents; it also has some memory care units, for a total of 55 beds.

Being near a high school and a two-year college is beneficial when it comes to training and recruiting staff, Goering said. That can be important, because there is competition for health care workers throughout the region. Health care facilities need to be staffed 24 hours a day, 365 days a year.

Goering calculated that it costs almost $114,000 per year to provide entry-level staffing around-the-clock for a year, not including benefits.

Blended staffing is one of the ways St. Crispin is addressing potential staffing shortages. Workers are being cross-trained so that each employee is qualified to perform more than one action.

Goering and most of the leadership team are licensed as nursing assistants so they can respond if there is a need.

When the move is made to the new campus this month, St. Crispin will have the same number of beds as now — 64 skilled nursing and 55 assisted living — but those beds will be in the same location rather than split between the Hi-Park area and the former Seminary Home.

Financing is another challenge, Goering acknowledged.

The Benedictine Health System is a mission-based, nonprofit health system headquartered in Duluth. It is sponsored by the Benedictine Sisters of St. Scholastica Monastery.

Their mission is to create "compassionate communities providing support to those we serve to live fully and live well, with special concern for the underserved and those in need."

That means accepting the poor and the powerless, Goering said. "We take in a good share of Medicaid, elderly 'waivered' and alternative care residents."

He pointed out that in Minnesota, nursing care facilities that participate in Medicaid cannot charge private patients more than they charge Medicaid patients. Rates are established by the Legislature as part of the Health and Human Services budget, resulting in fixed revenues.

The result: "We are losing money on Medicaid patients."

Goering added, "As taxpayers, we don't want to see the cost of health care go up."

As a business that is largely funded by federal and state programs, St. Crispin is in what he calls "the tension" between trying to meet the demands of the workforce and not being able to raise nursing home rates.

On top of that, they have to compete with unregulated industries and facilities that are not under the same restrictions.

"It's a high-risk business to be in," Goering said. "A for-profit venture would not be building this facility in this community. It wouldn't happen."

The assisted living program is not as closely restricted and it has access to programs and grants. Rates for private pay residents can reflect actual costs, he said. But those rates still must be competitive with other facilities.

Other factors add to the high-risk nature of the health care business. St. Crispin's clients are at great risk for falls, Goering pointed out. They made the move because of health and mobility issues; many are in cognitive decline; most require multiple medications.

"The regulatory oversight and levels of care surpass other available options," Goering said.

Because of all the challenges, he believes the St. Crispin Living Community — which has a price tag of about $13 million — may be the last project of its kind.

"Our community is really blessed to have a new facility in a time when so much pressure in public policy is on reducing cost, despite our aging population with higher care needs," Goering said.

"Catholic and other charitable folks built most of our health care system. Mission-driven, the Benedictine Sisters continue to stand in the gap to ensure Red Wing continues to have the best elder care possible."